When I was a teenager I did some stupid things, but looking back I think that the worst decision I made was to go to a tanning salon. At the time I remember tanning salon staff assuring me that it was “safer than the real sun” and the fastest way to get a healthy-looking glow. “You could bake in the sun all day, or spend 20 minutes in a tanning bed for the same effect” said the staff. So after trying several sunless tanners in varying shades of orange and having them slough off like patches of dirt, I decided to make my alabaster skin a nice, even shade of light caramel with months of tanning each year.

Fast forward twenty some-odd years and I’m in the surgeon’s office having a wide-margin re-excision of a melanoma on my back. I’d been wearing sunscreen since my early twenties, carefully protecting myself from UV radiation. I had realized the error of my ways after a serious conversation with a dermatologist, but I had “gotten religion” about skin protection too late. My fate was already set from the tanning bed exposure.

A new study in the British Medical Journal (BMJ)estimates that tanning beds may be responsible for hundreds of thousands of non-melanoma skin cancers per year in the United States. As for melanoma (the deadliest kind of skin cancer), the World Health Organization has determined that the risk of melanoma is increased by 75% when the use of tanning devices starts before age 30. In fact, they classify tanning bed exposure as a “group 1 carcinogen” – in the same class of human toxicity as asbestos, tobacco, and mustard gas.

I was surprised to learn how common tanning bed use is, especially in Europe. According to the BMJ study, 10.6-35% of people in Germany, France, Denmark, and Sweden have used a tanning bed at some point in their lifetimes. The global nature of this problem is daunting – and with research suggesting that tanning has addictive properties, it may be as difficult to get people to avoid tanning salons as it is to have them quit smoking.

As for me, I learned my lesson and I have the scars to prove it. I was lucky that a dermatologist caught my melanoma before it spread, but now I need to be on the look-out for more of them and redouble my efforts to stay out of the sun. If you’ve ever used a tanning bed and have fair skin and freckles, you should probably keep your dermatologist on speed dial. That temporary “sun-kissed glow” can easily turn into wrinkles and Frankenstein scars in the not too distant future – along with a potentially fatal cancer diagnosis. Trust me, it’s not worth it.

Dermatologists have done a great job promoting sun safety. We all know that we should use sunscreen or sunblock to avoid burns, and to reapply it religiously when we plan to be outdoors for long periods of time. But how often do we think about protecting our eyes from the same UV rays?

A dear friend of mine has been on a long-term medicine that makes her skin especially sun-sensitive. She did not take sufficient precautions to protect her eyes from UV radiation (though she always wore sunscreen on her skin), and she developed a pterygium that looks just like the photograph above. Her condition reminded me of the importance of eye protection, and I thought I’d offer you 5 excellent reasons to start shielding your eyes from the sun. UV protection is critical for avoiding:

1. Photokeratitis. Photokeratitis is essentially a sunburn of the front layer (cornea) of your eyeball. If you’ve ever had a burning sensation in your eyes after a long day at the beach, or in the snow, you may have burned your eyes. Just as skin sunburns are painful and take a few days to calm down, eye pain can be very uncomfortable. But worse than the temporary discomfort is the increased long-term risks of pterygia, cataracts, and other eye conditions (see below).

2. Pterygia. Pterygia are overgrowths of corneal tissue that can grow across the iris and pupil. They can be cosmetically unsightly, and can block vision if they grow large. They are caused almost exclusively by UV damage, and are most common in people who live near the equator (because their exposure to UV radiation is highest). Surgery is the only known treatment for pterygia, though as many as 50% grow back, and surgical divets in the cornea can cause visual problems.

3. Cataracts. Cataracts are opacities of the eye lenses that lead to partial or total blindness. The exact mechanism by which they occur is unclear, though we know that sun exposure contributes to their development. Cataracts are the number one cause of blindness in the world.

4. Skin Cancers. Basal cell carcinoma (BCC) is a type of skin cancer that primarily develops on skin that has been sunburned, especially in childhood. Melanoma is a deadly form of skin cancer that is much rarer than BCC, but also most commonly develops on skin that has been burned. Squamous cell carcinoma (SCC) is the least invasive type of skin cancer, and usually develops on skin that has had the largest total amount of sun exposure over a lifetime. People who don’t protect the thin eye skin and lids from UV radiation (beginning in childhood) are more likely to develop cancer around the eyes

5. Macular Degeneration. Exposure to the sun’s UV rays can cause damage to the deep structures of the eye, including the retina. Light focused on the macula (the most important part of the retina for vision) can cause damage in the area over time. Macular degeneration results in visual damage and even blindness.

Ok, so I hope I’ve convinced you that UV protection is critically important for your eyes… How can you protect yourself? There are 4 primary strategies:

1. Wear UV protective sunglasses. When buying sunglasses, check out their product labels and avoid glasses that are purely cosmetic – opt for those that block 99-100% of UV A and B rays. Larger glasses and wrap-arounds offer the most coverage. Remember that kids need sunglasses too!

2. Wear a wide-brimmed hat. Although a hat doesn’t always protect you from glare and light reflection from other surfaces, it can reduce the total amount of radiation that reaches your eyes and skin.

3. Wear UV-protective contact lenses. Most people don’t realize that some contact lenses are manufactured with a UV protective layer already built in. Although they are not large enough to protect the entire eye surface (or the skin around the eye) they offer an added layer of protection against harmful UV rays. However, not all contact lenses offer UV protection, and of those that do, not all provide similar absorption levels. An eye care professional can prescribe Class 1 UV-blocking contact lenses, which provide the greatest level of UV protection and which have a Seal of Acceptance for UV Absorbing Contact Lenses from both the American Optometric Association and the World Council of Optometry’s Commissions on Ophthalmic Standards. These lenses block more than 90 percent of UVA rays and 99 percent of UVB rays.

4. Protect your eyes all day. UV radiation for the eyes is actually worse when the sun is lower in the sky. Researchers at the Kanazawa Medical University in Japan found that during early morning and late afternoon, UV exposure to the eyes was about double that of the hours around noon during Spring, Summer and Fall.

For more information about protecting your eyes from the sun, you may enjoy listening to my recent interview with Dr. Stephen Cohen.* He is an optometrist who lives in Arizona – and is therefore well acquainted with UV radiation! Scroll down to the bottom of the page after clicking on the link and you’ll see the podcast.

***

Note that I was paid by Johnson & Johnson Vision Care, Inc. to host the radio show with Dr. Cohen.

The entire March issue of Archives of Dermatology appears to be dedicated to skin cancer — melanoma and non-melanoma.

Basal cell carcinoma (BCC) represents 65% to 75% of all skin cancers. Most occur on sun-exposed parts of the face, ears, scalp, shoulders, and back. Intense short-term UVB exposure is important in the formation of BCC. Clinical features include pearly translucent flesh-colored papules or nodules with superficial telangiectasias (broken blood vessels). More active lesions may have rolled edges or ulcerated centers.

Squamous cell carcinoma (SCC) represent 30% to 65% of all cutaneous malignancies. SCCs are most attributable to UVB exposure, long-term or accumulative exposure over years. Clinical features include crusted papules and plaques that may become indurated, nodular, or ulcerated. SCC may arise in chronic wounds, scars, and leg ulcers. Recurrent SCC development within 3 years is 18%, a 10-fold higher incidence compared with initial SCC diagnosis in the general population.

Malignant melanoma (MM) represents the most serious of all cutaneous malignancies. It is estimated that approximately 65% to 90% are caused by UV exposure, predominantly UVA. Roughly 10% of all melanoma cases are strictly hereditary. Read more »

Several years ago, I was telling a patient about the importance of doing routine screening for skin cancer – by far the most common type of cancer in the U.S., affecting over a million people a year. She volunteered that she was covered, that she was seeing a dermatologist routinely for Botox injections. “Does he do a complete head-to-toe exam?” I asked. Her pause and sheepish expression told me all I needed to know. She wasn’t at all covered – because she was never uncovered.

Fortunately, the majority of skin cancers found each year are basal cell or squamous cell – the types that have a very high chance of being cured. The National Cancer Institute estimated that fewer than 1,000 people died from these “non-melanoma” cancers in 2008. Melanoma is another story, affecting over 62,000 Americans a year and causing over 8,400 deaths. The majority of melanomas occur in older patients but almost 1 percent are diagnosed under age 20 and almost 8 percent are found between ages 20 and 34. So you’re never too young to start thinking about ways to prevent skin cancer and ways to keep track of what’s happening with your skin.

Since I was in medical school in the mid-’70s, the number of yearly cases in the U.S. has more than doubled. Early detection is likely one reason for the increase but nobody is exactly sure what has been causing the dramatic rise. What is clear, however, is that early detection is the name of the game when it comes to curing melanoma. The earlier a lesion is found, the better the chance of cure – which brings us to the main point of this blog. Everybody should be getting routine head-to-toe skin exams. This means looking from head to toe at every millimeter of your body, including where the sun doesn’t shine. Skin cancers can occur in any location of the body, including the armpits, scalp, between the toes, in the groin or anogenital area – anywhere! Routine self-exam should be part of your screening regimen. If a partner is available who can examine hard to see areas such as the small of the back – all the better.

In addition, I feel that routine screening should include a well-trained health professional who is interested in performing a careful skin exam. This is where it can get tricky. We live in a time when sub-specialists abound – even among dermatologists. A patient may see a cosmetic dermatologist several times a year for Botox injections. The dermatologist may glance at areas of exposed skin but the patient should not feel that a full screening skin exam is being routinely performed. The patient I described at the top of this blog had magical thinking – somehow reasoning that she’d received skin cancer screening just because she’d seen a dermatologist, even though she hadn’t taken her clothes off! Trust me: no doctor is good enough to detect skin cancer without examining the skin.

When the CBS Doc Dot Com team was brainstorming for segment ideas recently, producer Jessica Goldman came up with the idea of following her through a complete evaluation with a dermatologist. That brings us to today’s episode with New York City dermatologist Dr. Francesca Fusco, who covers a wide range of skin issues, from cancer prevention to cosmetic dermatology.

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